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Case Reports
. 2018 Nov 15:19:1362-1365.
doi: 10.12659/AJCR.913039.

An Unusual Case of Intestinal Malrotation Causing Duodenal Obstruction by a Looped Appendix

Hussein Hmadeh  1 , Christian Saliba  2 , Mohamad Raka  1 , Hammam Ahmad Farhat  1 , Ali Dabbous  1 , Samer Diab  2 , Layan Abbas  3 , Ali Wehbe  4
Affiliations
Case Reports

An Unusual Case of Intestinal Malrotation Causing Duodenal Obstruction by a Looped Appendix

Hussein Hmadeh et al. Am J Case Rep. .

Abstract

BACKGROUND Bowel obstruction is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Intestinal malrotation is one of the rarest causes of mechanical bowel obstruction. In adults, the incidence rate is 0.2%, and 15% of all patients with confirmed diagnosis remain asymptomatic throughout life. Surgery is generally required when the patient is symptomatic. CASE REPORT A 30-year-old man with multiple admissions for chronic intermittent colicky abdominal pain since childhood, was admitted for symptoms suggestive of proximal small bowel obstruction. Tomographic imaging identified a midgut malrotation and a duodenal obstruction by a non-diseased displaced appendix. Laparoscopic liberation of the duodenum and the terminal ilium was done successfully. CONCLUSIONS Intestinal malrotation is infrequently encountered in the adult population, but it should be kept in mind as a differential diagnosis whenever a case of acute intestinal obstruction in an adult presents without any significant past surgical history.

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Conflict of interest statement

Conflict of interest: None declared

Conflicts of interest

None.

Figures

Figure 1.
Figure 1.
Abdo-pelvic CT scan with IV and PO contrast showing the whirlpool sign (yellow arrow) involving the jejunal loops (red arrow) at the level of the Treitz angle.
Figure 2.
Figure 2.
Abdo-pelvic CT scan with IV and PO contrast showing a dilated duodenal loop (red arrow) with a deflated bowel transition zone (yellow arrow).
Figure 3.
Figure 3.
An intraoperative capture during laparoscopic exploration showing the highly positioned caecum (white arrow) and the base of the appendix (black arrow) covering the duodenum (yellow arrow).
Figure 4.
Figure 4.
An intraoperative capture during laparoscopic exploration showing the jejunum (black arrow) passing through the defect in the terminal ileum mesentery (white arrow).
Figure 5.
Figure 5.
An intraoperative capture during laparoscopic exploration showing the appendix (white arrow) wrapped around the dilated duodenum (black arrow).
Figure 6.
Figure 6.
An intraoperative capture during laparoscopic exploration showing the appendix (white arrow) wrapped around duodenum (black arrow).
See this image and copyright information in PMC

References

    1. Gamblin TC, Stephens RE, Jr, Johnson RK, et al. Adult malrotation: A case report and review of the literature. Curr Surg. 2003;60(5):517–20. - PubMed
    1. Vukie Z. Presentation of intestinal malrotation syndromes in older children and adults: Report of three cases. Croat Med J. 1998;39(4):455–57. - PubMed
    1. Maxon RT, Franklin PA, Wagner CW. Malrotation in the older child: Surgical management treatment and outcome. Am Surg. 1995;61(2):135–38. - PubMed
    1. Dietz DW, Walsh RM, Grudfest-Broniatowski S, et al. Intestinal malrotation: Rare but important cause of bowel obstruction in adults. Dis Colon Rectum. 2002;45(10):1381–86. - PubMed
    1. Kapfer S, Rappold J. Intestinal malrotation not just the pediatric surgeon’s problem. J Am Coll Surg. 2004;199:628–35. - PubMed

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